Video-assisted parathyroidectomy (VAP) is usually proposed for well localized parathyroid adenomas. Anyway, with VAP it's possible to achieve a complete bilateral neck exploration, when localization is uncertain or intraoperative quick PTH assay unavailable, and, when necessary, also for associated thyroid resections. 12 patients with sPHPT underwent VANE and were included in this study. Patients were selected because of inadequate preoperative localization of parathyroid adenoma in four cases and unavailability of quick intraoperative PTH assay in two cases. Bilateral neck exploration was performed through a 1.5-cm central skin incision, above the sternal notch. A 30 degree, 5 mm endoscope and the other endoscopic instruments were inserted through the same incision, without any trocar utilization, as already described for VAP. VANE allowed for the exploration of four glands in all the cases. a single enlarged parathyroid gland was identified and removed in all the cases. Final histology always confirmed the diagnosis of parathyroid adenoma. Five patients underwent concomitant thyroidectomy (4 total thyroidectomy, 1 lobectomy). The mean postoperative time was 70 min (range: 50-120 min). Serum calcium and PTH levels measured in I and II postoperative days and one month after surgery were normal. No postoperative complication was observed. Postoperative stay was two days in all cases. Cosmetic results was considered excellent by all the patients. VANE is feasible, safe and can be associated with video-assisted thyroid resection, when necessary. Even if its long-term results still need to be compared to those of the conventional procedure, VANE represents an attractive and promising minimally invasive alternative to conventional surgery in case of sPHPT with uncertain preoperative localization or in case of multiglandular disease.